ABSTRACT
OBJECTIVE: To evaluate the impact of obesity on surgical outcomes for women with endometrial cancer (EC) managed by laparoscopic surgery. Minimal invasive surgery has been incorporated in the surgical management of EC, improving perioperative outcomes. However, this approach may become more challenging in case of obesity. So it is important to accurately evaluate and establish the most appropriate surgical approach for these patients. MATERIALS AND METHODS: From January 2008 through April 2016, we conducted a prospective observational study, including all consecutive patients with a histological diagnosis of EC undergoing surgical staging by laparoscopy at our institution. Patients were classified in two groups (obese vs non-obese) according to their body mass index. Information about short- and long-term outcomes were recorded and analyzed during an outpatient follow-up. RESULTS: Between January 2008 and April 2016, 83 women underwent laparoscopic surgery for EC at our institution. Forty-six (56.6%) of them were classified as obese. Surgical outcomes were similar in both groups. No significant difference was reported in surgical time, number of lymph nodes removed, blood loss, length of hospital stay, and incidence of intra- or postoperative complications. Also, long-term outcomes did not show any statistical significant difference: recurrence rate was 6.4% (3/47) among obese patients and 13.9% (5/36) among non-obese (p = 0.251). No difference was reported even in time to recurrence (log-rank p = 0.280) and in survival time (log-tank p = 0.132) between the two groups. CONCLUSIONS: Our results show that obesity did not impair the outcomes of laparoscopic surgery for EC. This surgical approach may be offered to obese patients with the same level of safety, radicality, and efficiency as for the normal-weight population.
Subject(s)
Endometrial Neoplasms , Laparoscopy , Obesity , Endometrial Neoplasms/complications , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/surgery , Female , Humans , Laparoscopy/adverse effects , Laparoscopy/statistics & numerical data , Length of Stay/statistics & numerical data , Obesity/complications , Obesity/epidemiology , Postoperative Complications/epidemiology , Prospective Studies , Treatment OutcomeABSTRACT
Objetivos Evaluar la eficacia del tratamiento médico con metotrexato en el embarazo ectópico. Material y métodos Estudio prospectivo observacional del uso y eficacia del tratamiento médico con metotrexato en las pacientes diagnosticadas de embarazo ectópico en el Hospital General Universitario de Ciudad Real durante los años 2008 y 2009. Se administró dosis única intramuscular a aquellas pacientes que cumplieron los criterios de inclusión. Se consideró fracaso del tratamiento médico cuando después del mismo fue necesario tratamiento quirúrgico. Se analizaron los costes económicos del tratamiento médico y quirúrgico. Resultados Se diagnosticaron 63 casos de embarazo ectópico. Cuarenta pacientes (63,5%) fueron tratadas con metotrexato, y 23 (36,5%) fueron directamente intervenidas quirúrgicamente (salpingectomía laparoscópica) por no cumplir criterios de inclusión en el protocolo de tratamiento médico. De las que recibieron metotrexato, 30 pacientes (82,5%) necesitaron sólo una dosis y 10 (17,5%) precisaron 2 dosis. El tratamiento con metotrexato tuvo éxito en 30 pacientes (75%) y fracasó en 10 (25%), realizándoseles una salpingectomía laparoscópica. El coste por proceso del tratamiento médico fue de 580 euros, menor que el coste del tratamiento quirúrgico laparoscópico, 3.465,8 euros. Conclusiones El tratamiento con metotrexato del embarazo ectópico en pacientes seleccionadas es igual de eficaz que el tratamiento clásico con laparoscopia con un menor coste económico y con una gran aceptación por parte de la paciente (AU)
Objectives: To evaluate the eficacy of medical treatment with methotrexate in ectopic pregnancy. Material and methods: We performed a prospective observational study of the use and effectiveness of medical treatment with methotrexate in patients diagnosed with ectopic pregnancy in the Ciudad Real University General Hospital from 2008 to 2009. A single intramuscular dose was administered in patients who met the inclusion criteria. Medical treatment was considered to have failed when surgery was required. We analyzed the economic costs of medical and surgical treatment. Results: We diagnosed 63 cases of ectopic pregnancy. Forty patients (63.5%) were treated with methotrexate, and 23 women (36.5%) who did not meet the criteria for inclusion in the protocol for medical treatment were treated surgically (laparoscopic salpingectomy).Among patients who received methotrexate, 30 (82.5%) required only one dose and 10(17.5%) required two doses. Methotrexate treatment was successful in 30 patients (75%) and failed in 10 (25%), who underwent a laparoscopic salpingectomy. The cost per case of medical treatment was 580 D, which was less than the cost of laparoscopic surgical treatment(3,465.8 D).Conclusions: Metho trexate treatment of ectopic pregnancy in selected patients is as effective as the standard treatment with laparoscopy with less cost and with high acceptance by patients (AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy, Ectopic/drug therapy , Methotrexate/therapeutic use , Laparoscopy , Evaluation of Results of Therapeutic InterventionsABSTRACT
La corioamnionitis candidiásica es un suceso raro que afecta al 0,8% de las embarazadas, pero que se asocia a malos resultados perinatales. No se conoce hoy en día, con exactitud, la etiopatogenia ni los factores implicados en el desarrollo de IIA candidiásica. Al igual que ocurre con las infecciones de causa bacteriana, aún no se dispone de una forma fiable de prevenir, detectar o tratar la IIA candidiásica que causa parto prematuro o aborto tardío. Se presenta un caso clínico de aborto tardío con informe histológico de corioamnionitis por hongos y se revisa la bibliografía en busca de las causas que lo producen, si se puede prevenir y su tratamiento (AU)
Mycotic vulvovaginitis (mostly due to Candida) during pregnancy has a reported incidence of 20%-25%. However, obstetric complications caused by this microorganism are rare, the incidence of chorioamnionitis being 0.8%. Intra-amniotic candidal infections can produce abortion, preterm delivery, rupture of membranes, and chorioamnionitis. We present a case of late spontaneous abortion with a histologic diagnosis of fungal chorioamnionitis and review the literature to identify causes, their possible prevention, and treatment (AU)
Subject(s)
Humans , Female , Adult , Pregnancy , Chorioamnionitis/complications , Chorioamnionitis/pathology , Pregnancy Complications/diagnosis , Candida/isolation & purification , Candida/pathogenicity , Risk Factors , Fungi/isolation & purification , Fungi/pathogenicity , Metrorrhagia/complications , Abdominal Pain/complications , Infant MortalityABSTRACT
El embarazo ectópico intersticial es un suceso raro, con gran morbimortalidad para la paciente si se diagnostica de forma tardía. Las opciones actuales de tratamiento son el empleo de metotrexato o bien el tratamiento quirúrgico. No se ha establecido aún cuál de ellas es la mejor opción. En publicaciones recientes se considera que el tratamiento médico es un método aceptable si se hace una selección adecuada de la paciente y un seguimiento estricto tras la aplicación de metotrexato (AU)
Interstitial pregnancy is a rare event, which produces high morbidity and mortality if diagnosis is delayed. Current treatment options consist of methotrexate or surgery. Which of these two options is the most effective remains to be established. Recent publications consider medical treatment as an acceptable method when there is appropriate patient selection and close follow-up after methotrexate therapy (AU)
Subject(s)
Female , Pregnancy , Humans , Pregnancy, Ectopic , Pregnancy, Ectopic/surgery , Treatment OutcomeABSTRACT
La villitis de origen desconocido supone un importante desafío para la patología perinatal. A menudo se asocia con crecimiento intrauterino retardado, abortos de repetición y muerte fetal tardía. La frecuencia de esta afección es de, aproximadamente, entre el 5 y el 8 por ciento en estudios placentarios consecutivos. La etiología es desconocida, y no es el resultado de infección por patógenos habituales (AU)
